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Photo of the publication cover. VFC Vaccine Administration Form (Part B) Immunization - Form October 1, 2021

This form allows you to provide immunization information for entry into NMSIIS.

VFC Vacuna Forma Administración (Parte B)



Photo of the publication cover. Adult Vaccine Consent Form Immunization - Form October 1, 2021

This form may be used by adult patients aged 19 and older to provide vaccination consent to a healthcare provider.

Adultos Vacuna Formulario de Consentimiento



Photo of the publication cover. Adult TSR Form Immunization - Form August 30, 2021

Adult TSR Form





Photo of the publication cover. COVID-19 Vaccine Consent Form English Immunization - Form March 25, 2021

This form should be used as Consent for COVID-19 Vaccinations



Photo of the publication cover. COVID-19 Vaccine Consent Form Spanish. Immunization - Form February 25, 2021

This form should be used as Consent for COVID-19 Vaccinations



Photo of the publication cover. NMSIIS User Security and Confidentiality Agreement Immunization - Form January 4, 2021

User security and confidentiality agreement for the New Mexico Statewide Immunization Information System.



Photo of the publication cover. NMSIIS Participant Organization Security and Confidentiality Agreement Immunization - Form January 4, 2021

Participant organization security and confidentiality agreement for the New Mexico Statewide Immunization Information System.



Photo of the publication cover. NMSIIS Decision to Remove Record Immunization - Form January 4, 2021

This form is used by a patient/parent/legal guardian to remove records from the New Mexico Statewide Immunization Information System.



Photo of the publication cover. NMSIIS Decline to Participate Form Immunization - Form January 4, 2021

This form is used by a patient/parent/legal guardian to decline to participate in the New Mexico Statewide Immunization Information System.



Photo of the publication cover. COVID-19 Vaccine Consent Form Spanish Immunization - Form December 18, 2020

This form should be used as Consent for COVID-19 Vaccinations



Photo of the publication cover. VFC COVID-19 Troubleshooting Record Form Immunization - Form December 15, 2020

This form should be used to report out of range temperature incidents and submit a troubleshooting record to the vaccines for children program.



Photo of the publication cover. VFC Metro Region Temperature Log Form Immunization - Form June 29, 2020

County: Bernalillo



Photo of the publication cover. VFC Northeast Region Temperature Log Form Immunization - Form June 29, 2020

Colfax, Guadalupe, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, and Union



Photo of the publication cover. VFC Northwest Region Temperature Log Form Immunization - Form June 29, 2020

Cibola, McKinley, San Juan, Sandoval, Torrance, and Valencia



Photo of the publication cover. VFC Southeast (A) Region Temperature Log Form Immunization - Form June 29, 2020

Chaves, Curry, DeBaca, Lincoln, and Quay



Photo of the publication cover. VFC Southeast (B) Region Temperature Log Form Immunization - Form June 29, 2020

Eddy, Lea, Lincoln, and Roosevelt

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